It can feel like a race against time to fully recover from a serious illness. You naturally want to begin your therapy as soon as your doctor has diagnosed your issue and decided the best course of action.
Most medical illnesses deteriorate without treatment, and some may even progress over time from being curable to fatal. Your ability to complete a full recovery may be jeopardized if your insurance provider takes too long to respond to your request for benefits and you are kept waiting for the care you require.
State law requires California health insurance companies to respond to claims as soon as possible. If they don't, you might have a case to sue your insurer. An expert Los Angeles, bad faith insurance lawyer, can assist insurance customers who have been subjected to an unreasonable amount of waiting time for a response to a benefit claim to recover damages for the insurer's bad faith behavior.
According to California law, benefits claims must be responded to quickly.
The legislation in California holds insurance providers to a high level. According to the California Code of Regulations, insurance companies must respond to a benefit claim within 15 days and decide whether to approve or deny it within 40 days.
Although breaking these deadlines is one method insurers might break the legislation requiring a quick response to claims, there are frequently more cunning ways for insurance firms to delay paying claims. Insurance companies frequently demand the submission of numerous documents or redundant forms.
They can assert that a form you previously sent was misplaced in the mail. Before approving a claim, they can say that they are awaiting a medical professional's assessment of your situation. All of these tactics have the potential to violate your legal rights when employed strategically.
In the state of California, an implied covenant of good faith and fair dealing exists in every contract. If a consumer suffers harm as a result of an insurer's unreasonable delay in responding to a claim, they may be entitled to financial compensation through legal action.
Furthermore, according to California Insurance Code 790.03, it is unfair practise for an insurer to fail to reply "reasonably promptly" to consumer interactions, to investigate and process claims, or to settle claims.
In order to obtain the financial compensation you are due for your insurer's bad faith in failing to respond to your claim, an experienced insurance bad faith attorney will rely on these and other laws, as well as a careful examination of your case and proof of your entitlement to the benefits specified in your claim.
Insurance Companies Can Be Sued for Unreasonable Delay
Everyone is aware that an insurance typically denies claims and then questions you, daring you to disagree with the decision. What if, however, all they are doing is posing queries? or making a document request? further documents after that? And you can't seem to get a response about whether your claim is accepted or will be rejected?
Even before they render a negative claim verdict, insurers can be held liable for undue delays in the claim process. You can enforce your legal rights in court to compel an insurer to act if they failed to promptly investigate the claim, demanded excessive types and/or amounts of documentation, or simply did not return your calls, emails, or letters.
Insurance companies have long used the tactic of delay to either get claims to give up or get a reduced settlement amount. The best way to avoid delays is to employ a skilled insurance bad faith lawyer. An attorney with experience in insurance coverage and bad faith is often not ignored by insurers. And if they do, a knowledgeable bad faith attorney will know what to do and might launch a lawsuit right away to safeguard your rights and seek restitution.
Contact the insurance coverage and bad faith specialists in Orange County at the Winthrop Law Group to make sure your legal rights are protected at every stage of the process if your insurance provider is giving you the run around, ignoring your claims, or leaving your home or business unprotected, particularly during these times.
When can I take the insurance company to court over a denied claim?
Every insurer owes its policyholders a number of duties. They must follow the guidelines of the agreement (the policy), behave honestly, and refrain from unscrupulous business tactics.
Since the insurance sector is often governed at the state level, their specific responsibilities differ from state to state. However, in accordance with these requirements, the insurance provider must generally refrain doing the following:
Insufficient and ineffective investigation of the claim
denying payment for a claim when responsibility is indubitably obvious
a claim's approval or denial not occurring promptly
denying a claim without providing enough justification or even any justification at all
not defending you in a liability case where your liability insurance may protect at least one claim
denying a claim due to an application error after the contestability period has passed